MOOD DISORDERS IN THE FEMALE-PATIENT

Disruptive changes in mood and low energy level are among the most com mon reasons women consult a physician. Usually no clear physiological explanation for these changes can be found. Many physicians feel uncom fortable dealing with patients with these complaints. The purpose of t his paper is to discuss a practical approach to helping women with suc h conditions. A variety of terms have been utilized to refer to the si tuation in which a female patient has decreased energy or labile mood. Premenstrual Syndrome (PMS) and chronic fatigue syndrome (CFS) are cu rrently popular terms. An association of low mood with menstrual cycle phase is undoubted, with the late luteal-early premenstrual phase mos t commonly associated with depression and irritability. It seems likel y that women with PMS and those without it do not differ in circulatin g hormone levels during their cycles but rather in the brain response to these. Estrogen and progesterone receptors exist in the brain and c hange during the cycle. Elaborate diagnostic efforts are rarely reward ing in managing mood and energy disorders. Of more value is a careful history particularly concerned with the pattern of mood changes and wi th life stresses, accompanied by a thorough physical examination and l aboratory tests. In most cases, changes in mood and energy are a varia nt of clinical depression. Changes in energy and sleep may be more evi dent than low affect. Treatment with an appropriate antidepressant, us ually a selective serotonin re-uptake inhibitor (SSR), benefits most o f these patients. Allowing the patient to express concerns about stres sful life situations is often of great value.